You will be asked to examine the hands
- [LOOK + SCREENING]
- Note the presence of nodules, cords and pitting of along the ring finger, concerns of Duputryen's disease
- Before I proceed, will go on to screen the hand for other concomittant pathologies
- Dorsum - Garrod's pads
- Palm - scars
- "At this point, the goal of my assessment are 2 fold"
- Look for signs of Dupuytren's Diasthesis - aggressive disease
- Look for indications for surgery
- Before I go on, can i ask you a few questions?
- How old when these started? < 40 yo
- Any family history?
- Any similar condition in penis and foot?
- "I also note this is on the ring finger, not radial sided"
- As such this patient do not have signs of dupuytren's diasthesis
- [FEEL] "I will go on to FEEL your hand"
- Feel each finger
- Starting from thumb - no cords along FPL, no comissure cords
- Feel the affected finger from palm
- Central of palm and finger - pre-tendinous cords from the MCPJ down to the proximal phalanx
- DIPJ - "No DIPJ retrovascular cords"
- Lateral aspects of finger - "lateral or spiral cords"
- Web spaces - "Natatory cords"
- Evaluate ROM by:
- Checking PIPJ with flexion of the MCPJ
- Check MCPJ
- Specific tests
- Hueston’s table top test (failure to put hand flat on table indicates either a PIP joint flexion contracture or an MCP joint flexion contracture)
- Digital Allen's test!!
- Screen for Carpal Tunnel Syndrome - 2 muscles, 3 tests
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